Concordancia entre la percepción materna y el estado nutricional de sus hijos antes y después de una intervención educativa / Concordance between maternal perception and child's nutritional status before and after an educational intervention

RESUMEN La malnutrición por exceso es un problema de salud y su rápida pesquisa mediante percepción materna (PM), permite intervenciones tempranas enfocadas a disminuir sus consecuencias y costos asociados. El objetivo fue determinar la concordancia entre PM y estado nutricional (EN) de sus hijos, antes y después de una intervención educativa. Participaron 116 diadas madre-hijo de 2 a 5 años, de 4 jardines de Viña del Mar, donde se determinó EN y PM mediante imágenes corporales de los niños. Posteriormente, 57 madres con PM erradas respecto a estado nutricional de su hijo participaron de una intervención educativa de 40 minutos cada 15 días por 3 meses. La concordancia entre el PM y estado nutricional fue evaluada con el test de Kappa. El EN de los niños fue: 3,4% bajo peso; 49,1% normal; 28,4% sobrepeso y 19,0% obesidad. Para la PM el 99,1% subestimó el EN de su hijo (Kappa= 0,022 y p= 0,610). Posterior a la intervención, mejoró la PM en 59,6% y un 40,3% continuó subestimando el EN (kappa= 0,362 y p= 0,000). En este estudio, la PM tiende a subestimar el EN de sus hijos y una intervención educativa mejoró la PM y la concordancia entre PM y el EN de ellos.

ABSTRACT Overnutrition is a health problem and its rapid diagnosis through maternal perception (MP), allows for early intervention focused on reducing consequences and associated costs. The objective of this study was to determine the concordance between MP and child's nutritional status, before and after an educational intervention. Participants were 116 mother-child (2 to 5 years old) dyads from, from 4 daycare centers in Viña del Mar, Chile. Nutritional status was determined and MP was performed using children's body images. Subsequently 57 mothers with MP discordant with child's nutritional status participated in a 40-minute educational intervention every 15 days for 3 months. Concordance between MP and child's nutritional status was evaluated with Kappa. Nutritional status of the 116 children was: 3.4% underweight; 49.1% normal; 28.4% overweight, 19.0% obesity. MP indicated that 99.1% underestimated their child's nutritional status (Kappa = 0.022 and p= 0.610). After intervention, MP improved to 59.6% and 40.3% continued to underestimating child's nutritional status (kappa= 0.362 and p= 0.000). In this study, mothers tended to underestimate the nutritional status of their children. An educational intervention improved MP and the agreement between MP and child's nutritional status.

Clinical research in pediatric organ transplantation

Solid organ transplantation has greatly improved survival in children with end-stage disease, becoming one of the main treatment options in this population. Nonetheless, there are significant challenges associated with validating and optimizing the effects of these interventions in clinical trials. Therefore, we reviewed the main issues related to conducting clinical transplantation research in children. We divided these challenges into three different categories: (i) challenges related to surgical techniques and anesthetic procedures, (ii) challenges related to post-transplant care and (iii) challenges specific to a particular population group and disease type. Some of the observed burdens for clinical research in this field are related to the limitations of conducting studies with a placebo or sham procedure, determining the standard of care for a control group, low prevalence of cases, ethical concerns related to use of a placebo control group and lack of generalizability from animal studies and clinical trials conducted in adult populations. To overcome some of these barriers, it is necessary to utilize alternative clinical trial designs, such as observational studies or non-inferiority trials, and to develop multicenter collaborations to increase the recruitment rate. In conclusion, the lack of robust data related to pediatric transplantation remains problematic, and further clinical trials are needed to develop more efficacious and safer treatments.